In addition to being a major societal issue, the affordability of cancer care has prompted major changes in the way the United States pays for services and incentivizes outcomes, according to a new report from the American Society of Clinical Oncology. And those who struggle financially due to their cancer have a higher risk of dying.
Even among the insured, a cancer diagnosis can prove to be financially catastrophic. In looking at a number of different studies, the ASCO determined that as much as 78 percent of cancer survivors experience financial hardship due to their treatments, while one third of U.S. cancer survivors aged 18-64 incurred debt. Of those, 55 percent owed more than $10,000, and about 3 percent declared bankruptcy.
That financial strain often manifests as physical and emotional distress, with one study showing a group of lung and colorectal cancer patients experiencing more pain and symptoms the fewer financial reserves they had.
As healthcare costs have risen, insurers have shifted more of the financial burden of care to consumers -- meaning Americans are paying more for insurance than ever before, according to the ASCO. Employers and individuals gravitated toward high cost-sharing plans in 2016 and have accepted more financial risk for low monthly premiums, but there's a trade-off. Plans with high deductibles, limited networks of speciality providers and high drug copays can translate into higher out-of-pocket costs for cancer patients.
One area of concern for these patients, the study said, is inconsistency when it comes to cost sharing for oral and intravenous drugs. Copays can be a lot higher for oral therapies when they're covered through prescription drug benefits as opposed to traditional chemotherapy covered through physician office visits. The reason: The latter have to be delivered by infusion.
Based on a recent simulation model, as oral therapies replace infusion chemotherapy as the main form of treatment for leukemia, Medicare patients see higher out-of-pocket expenses. In fact, they experienced a five-fold increase from 2011 to 2025, from $9,200 to $57,000, the ASCO said.
In the ACA marketplace, premium costs have increased with each new enrollment period, and Medicare in particular has shifted these increasing costs back to its beneficiaries, who the ASCO said are particularly susceptible to cancer. From 2002 to 2010, those covered by Medicare averaged $8,115 annually for their out-of-pocket medical expenses, almost one-quarter of their income.
The high price of oncology drugs is another hardship -- Medicare spent $182,973 annually per beneficiary on the oncology drug lenalidomide, amounting to $11,538 in out-of-pocket costs per patient; imatinib was $122,804 for Medicare, or $8,503 for patients; and those who were given abiraterone paid $7,277 of $97,025.
The findings come as demand for cancer care is increasing, particularly as Americans live longer. However, the study found that the Affordable Care Act has made cancer care more accessible.